MEDICAMENTE HIPOLIPEMIANTE

1. Inhibitori de HMG Co-A Reductaza

Atorvastatin(Sortis)
Fluvastatin(Lescol)
Pravastatin(Lipostat)
Simvastatin(Zocor, Mivastin)

cpr.10,20,40,80 mg
D=10-80 mg/zi
cpr. 20, 40, cpr.ret 80 mg
D=20-40 mg/zi
cpr. 10 mg, 20 mg, 40 mg
D=10-40 mg/zi
cpr. 10, 20, 40, 80 mg
D=10-40 mg/zi

2. FIBRATI
Bezafibrat(Regadrin B)

cpr. 200 mg, 400 mg

D=200 mg x3/zi
cpr. 100 mg
D=100 mg/zi
cpr. 100 mg, 200 mg
D=100 mg x 3/zi, 200 mg/zi
cpr. 300 mg
D=900 mg/zi

Ciprofibrat(Lipanor)
Fenofibrat(Lipanthyl)
Gemfibrozil(Innogem)

3. Rasini schimbatoare
Colestiramina
Colestipol

pulv.500 mg, 4-8x2 ling/zi

4.Acidul nicotinic si analogi

Acipimox(Olbetam)

caps. 250 mg
D=500-750 mg/zi
cpr. 100 mg
D= 3 g/zi

Acidul Nicotinic

5.Alte hipolipemiante
Neomicina
Probucol
Acid Omega 3 Esteri etilici
(Omacor)

cps 1000 mg

Obiectivele tratamentului hipolipemiant

Tratamentul Hipolipemiant trebuie sa fie mai agresiv la pacientii cu boala manifesta fata de indivizii
la care se administreaza ca tratament profilactic.
STRATEGIE

CONCENTRATIE PLASMATICA

Profilaxie primara
- barbat, <35 ani si femeie in premenopauza
- barbat > 35 ani si femeie > 45 ani cu < 2 factori de risc CV
- adult cu > 2 factori de risc CV
-adult cu Dz sau cu AHC de boala CV precoce

Profilaxie secundara

LDL colesterol<190 mg/dl

LDL colesterol <160 mg/dl
LDL colesterol <130 mg/dl
LDL colesterol <110 mg/dl
LDL colesterol <100 mg/dl

EFECTELE STATINELOR ASUPRA CONCENTRATIEI SERICE A LIPIDELOR LA DOZE

UZUALE
Medicament
Atorvastatin 10 mg
20 mg
40 mg
80 mg
Cerivastatin 0,2 mg
0,3 mg
Fluvastatin 20 mg
40 mg
80 mg
Lovastatin 10 mg
20 mg
40 mg
80 mg
Pravastatin 10 mg
20 mg
40 mg
Simvastatin 5 mg
10 mg
20 mg
40 mg

Colesterol total
- 29
- 33
-37
-45
-17
- 19
-17
-21
-27
-16
-17
-22
-29
-16
-24
-25
-17
-24
-25
-28

LDL colesterol
-39
-43
-50
-60
-25
-28
-22
-24
-32
-21
-24
-30
-40
-22
-32
-34
-24
-33
-33
-40

Trigliceride
-19
-26
-29
-37
-10
- 12
-7
-9
-10
-10
-14
-19
-15
-11
-24
-10
-10
-19
-19

HDL colesterol
+6
+9
+6
+5
+10
+10
+4
+6
+5
+7
+7
+9
+7
+2
+12
+7
+9
+11
+12

SCHEME TERAPEUTICE
Lipide crescute

Medicament

Colesterol

1.Inhibitor HMG Co-A reductaza

2.Fibrati sau rasini

Colesterol + Trigliceride

1.Fibrati
2. Inhibitor HMG Co-A reductaza
Sau derivati acid nicotinic

Trigliceride

1. Fibrati
Sau derivati acid nicotinic sau acid
Omega 3- esteri etilici

EFECTUL MEDICAMENTELOR HIPOLIPEMIANTE ASUPRA NIVELULUI PLASMATIC A

LIPIDELOR CIRCULANTE SI AL LIPOPROTEINELOR
Medicament
Inhibitori HMG
Co-A reductaza

Fibrati
Rasini
Analogi acid nicotinic

Colesterol

Trigliceride

VLDL

LDL

HDL

HIPERLIPIDEMII PRIMARE
Tip de Hiperlipidemie
Hipercolesterolemia poligenica
Hipercolesterolemia familiala
Hiperlipidemia familiala combinata
Hiperlipoproteinemia Remnant

Colesterol

Trigliceride
LDL

Lipoproteine
IIa

LDL,VLDL

LDL
IIa,IIb,IV

LDL,CM

III

Hipertrigliceridemia familiala

VLDL,CM

IV, V

Chilomicronemia

VLDL,CMI,V

CAUZE DE HIPERLIPOPROTEINEMIE SECUNDARA

1.HIPERTRIGLICERIDEMIE
Diabet zaharat
Obezitate
Alcoolism
Insuficienta renala cronica
Boli hepatice cronice
Colestaza
Litiaza biliara
Boli hepatocelulare
Hepatocarcinom
Medicamente:estrogeni
2.HIPERTRIGLICERIDEMIE CU HIPERCOLESTEROLEMIE
Diabet zaharat
Hipotiroidism
Sindrom nefrotic
Transplant renal
3.HIPERTRIGLICERIDEMIE CU HDL REDUS
Beta blocante neselective
Norgestrel
Isotretinoin (analog vit. A)

Tip

IIa,IIb